This document discusses two techniques for front of neck access (FONA) in emergency situations: needle cricothyroidotomy and scalpel bougie. It provides details on the equipment and steps for performing the scalpel bougie technique, including making a transverse stab incision when the cricothyroid membrane is palpable or a vertical incision when impalpable. The document also outlines the equipment and procedure for performing a needle cricothyroidotomy using a 14G cannula and syringe to confirm placement in the trachea before supplying oxygen. Both techniques are described as options for establishing an airway when standard methods are not possible.

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Front of neck access

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Front of neck access (FONA)
 Many names
 Needle cricothyroidotomy vs scalpel bougie
 Which one to choose?

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Technique – Scalpel/bougie
 Equipment
 Scalpel – 10
 Bougie
 ETT 6mm ID
 Laryngeal handshake

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Technique – Scalpel/bougie
 Palpable membrane
 Transverse stab
 Turn blade through 900
 Slide bougie coude tip along blade
into trachea
 Railroad 6mm ETT into trachea
 Ventilate inflate cuff and confirm
position
 Secure tube

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Technique – Scalpel/bougie
 Impalpable membrane
 8-10cm vertical incision caudad to
cephalad
 Blunt dissection with fingers to separate
tissues
 Identify and stabilise the larynx
 Proceed with technique for palpable
anatomy

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Technique - Needle
 Equipment
 14G cannula
 5 mL syringe
 Water/Saline
 Source of O2 – Jet/rapid O2/Macgyver
 Laryngeal handshake
 Insert cannula at 450 while aspirating
 Advance cannula off trocar
 Remove trocar
 Reattach syringe to confirm aspiration
 Supply O2 and secure cannula
 Plan for conversion – Melker or other kit